System and method for repairing articular surfaces

ABSTRACT

A total joint replacement system comprising a first and a second implant system. The first implant system includes a first implant having a first load bearing surface based on a first removed portion of an articular surface of a patient&#39;s first bone, and a first anchor having a first threaded region configured to be secured into the first bone, wherein the first anchor is configured to be secured to the first implant. The second implant system includes a second implant having a second load bearing surface based on a second removed portion of an articular surface of a patient&#39;s second bone, and a second anchor having a second threaded region configured to be secured into the second bone, wherein the second anchor is configured to be secured to the second implant.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/973,981, filed May 8, 2018, which is a continuation of U.S. patentapplication Ser. No. 14/640,774 (now U.S. Pat. No. 9,962,265), filedMar. 6, 2015, which claims the benefit of U.S. Provisional ApplicationSer. No. 61/949,774, filed Mar. 7, 2014; U.S. Provisional ApplicationSer. No. 61/949,789, filed Mar. 7, 2014; U.S. Provisional ApplicationSer. No. 61/949,824, filed Mar. 7, 2014; and U.S. ProvisionalApplication Ser. No. 61/950,762, filed Mar. 10, 2014, the entiredisclosures of which are fully incorporated herein by reference.

FIELD

The present disclosure relates to delivery systems for bone implants,and more particularly, to delivery systems for articular surfaceimplants.

BACKGROUND

Articular cartilage, found at the ends of articulating bone in the body,is typically composed of hyaline cartilage, which has many uniqueproperties that allow it to function effectively as a smooth andlubricious load-bearing surface. When injured, however, hyalinecartilage cells are not typically replaced by new hyaline cartilagecells. Healing is dependent upon the occurrence of bleeding from theunderlying bone and formation of scar or reparative cartilage calledfibrocartilage. While similar, fibrocartilage does not possess the sameunique aspects of native hyaline cartilage and tends to be far lessdurable.

In some cases, it may be necessary or desirable to repair the damagedarticular cartilage using an implant. One method of installing animplant involves applying a blunt force, e.g., a hammer/mallet or thelike, to the implant. Unfortunately, some of the blunt force istransmitted from the implant into the surrounding bone and/or tissue andcan cause damage to the bone/tissue. This is particularly problematic insmall bones (such as, but not limited to, bones in the hand and/or foot)as well as patients who suffer from reduced bone mass and density thatcan lead to fracture (such as, but not limited to, osteoporosis or thelike).

BRIEF DESCRIPTION OF THE DRAWINGS

Features and advantages of the claimed subject matter will be apparentfrom the following detailed description of some example embodimentsconsistent therewith, which description should be considered withreference to the accompanying drawings, wherein:

FIG. 1 generally illustrates a total joint replacement system installedin a patient's joint consistent with at least one embodiment of thepresent disclosure;

FIGS. 2 and 3 generally illustrate one embodiment of an implant systemwhich may be used with the total joint replacement system consistentwith at least one embodiment of the present disclosure;

FIG. 4 generally illustrates another embodiment of an implant systemwhich may be used with the total joint replacement system consistentwith at least one embodiment of the present disclosure;

FIGS. 5 and 6 generally illustrate a further embodiment of an implantsystem which may be used with the total joint replacement systemconsistent with at least one embodiment of the present disclosure;

FIGS. 7 a-7 e generally illustrate cross-sectional views of anotherembodiment of the total joint replacement system consistent with atleast one embodiment of the present disclosure at different angles;

FIG. 8 generally illustrates a further embodiment of an implant systemwhich may be used with the total joint replacement system consistentwith at least one embodiment of the present disclosure;

FIG. 9A generally illustrates one embodiment of an implant deliverysystem which may be used with the total joint replacement systemconsistent with at least one embodiment of the present disclosure;

FIG. 9B generally illustrates a close up region of the implant deliverysystem of FIG. 9A;

FIGS. 10-12 generally illustrate various steps in the installation of ananchor consistent with at least one embodiment of the presentdisclosure;

FIG. 13 generally illustrates an anchor secured in the bone consistentwith at least one embodiment of the present disclosure;

FIGS. 14-17 generally illustrate various steps in theinstallation/coupling of the implant with an anchor consistent with atleast one embodiment of the present disclosure;

FIG. 18 generally illustrates yet another embodiment of an implantsystem which may be used with the total joint replacement systemconsistent with at least one embodiment of the present disclosure; and

FIG. 19 generally illustrates a further embodiment of an implant systemwhich may be used with the total joint replacement system consistentwith at least one embodiment of the present disclosure.

DETAILED DESCRIPTION

With reference to FIG. 1 , one embodiment of total joint replacementsystem 1 installed in a patient's joint 2 is generally illustrated. Thetotal joint replacement system 1 may include two or more implant systems10 (e.g., a first and a second implant system 10 a, 10 b) installed inthe articular surface 12 a, 12 b of a patient's bone 14 a, 14 b,respectively. Each one of the implant systems 10 is configured to repairand/or replace the articular surface 12 a and/or 12 b (referred to asarticular surface 12 for simplicity) of a respective one of thepatient's bones 14 a and/or 14 b (referred to as bone 14 forsimplicity). The total joint replacement system 1 may be used withimplant systems 10 for replacing any articular surface 12 such as, butnot limited to, shoulder joints (e.g., but not limited to, theglenohumeral joint), hip joints (e.g., but not limited to, theacetabulofemoral joint), foot and/or hand joints (e.g., but not limitedto, metacarpophalangeal joints, metatarsophalangeal joints, and/orinterphalangeal joints), knee joints, elbow joints, or the like. One ormore of the implant systems 10 may include total joint implants (whereinall or substantially all of the articular surface of at least one boneis replaced with the artificial surface of the implant) and/or partialimplants (wherein substantially only the damaged portion(s) of thearticular surface 12 of a bone 14 is replaced with the artificialsurface of the implant). As explained herein, the implant systems 10 a,10 b as illustrated in FIG. 1 are for illustrative purposes only, andthe total joint replacement system 1 may be used with any implant system10 as described herein.

Turning now to FIGS. 2-3 , one embodiment of an implant system 10 whichmay be used with the total joint replacement system 1 consistent withthe present disclosure is generally illustrated. For example, FIG. 2generally illustrates one embodiment of an exploded, unassembled implantsystem 10, and FIG. 3 generally illustrates an assembled implant system10. The implant system 10 may generally include an implant (e.g.,implant body) 16 configured to be secured to an anchor 18. The anchor 18is configured to be secured to the bone 14 within an excision site 20formed beneath the patient's articular surface 12 such that a loadbearing surface 22 of the implant 16 is generally flush with thepatient's surrounding articular surface 12 as generally illustrated inFIG. 1 .

The load bearing surface 22 may have any surface contour depending onthe intended application. The load bearing surface 22 may be based on orgenerally correspond to the original contour of the patient's removedarticular surface. For example, the load bearing surface 22 may have acontour substantially corresponding to or based on the contour of anarticular surface of a patient being repaired. The contour of the loadbearing surface 22 may be based on a plurality of measurements taken atthe patient's articular surface (for example, using a measuring and/ormapping tool as generally described in U.S. Pat. Nos. 6,520,964,6,610,067, 6,679,917, 7,029,479 and 7,510,558, which are fullyincorporated herein by reference) and/or may be based on one or moretemplates.

The load bearing surface 22 may be based on two or more curvatures, forexample, the anterior-posterior curvature and the superior-inferiorcurvature. One or more of the anterior-posterior and/orsuperior-inferior curvatures may themselves be based on multiple curves,(for example, as generally described in U.S. patent application Ser. No.12/027,121, filed Feb. 6, 2008 and entitled System and Method for JointResurface Repair, which is fully incorporated herein by reference).

While the load bearing surface 22 in FIGS. 2 and 3 is illustrated havinga generally convex contour, it should be appreciated that the loadbearing surface 22 is not limited to this configuration and will dependon the intend application. For example, the load bearing surface 22 mayinclude, but is not limited to, generally concave configurations (e.g.,as generally illustrated in FIG. 1 ) and/or generally hemi-sphericalshapes.

The excision site 20 may be formed using any method and system known tothose skilled in the art, such as, but not limited to, as the systemsand methods as described in U.S. Pat. Nos. 6,520,964, 6,610,067,6,679,917, 7,678,151, 7,896,883, 8,177,841, and 8,388,624, as well asU.S. Publication No. 2010/0368238, all of which are fully incorporatedherein by reference. According to one embodiment, the anchor 18 may besecured to the bone 14, for example, using one or more external threads,ribs, protrusions, bone cement, barbs, grooves or any other structure 21that enables the anchor 18 to be secured to the bone 14. The use ofthreads 21 as generally illustrated may advantageously allow the heightof the implant 12 to be adjusted by rotating the anchor 18 within thebone 14 such that the implant 16 is flush with the surrounding articularsurface 12.

The anchor 18 is configured to engage and/or secure the implant assembly10 to the patient's bone as described herein. Anchor 18 includes aproximal and a distal end region, and optionally may include acannulated passageway 40. The cannulated passageway 40 may be configuredto be advanced over a guide wire (not shown) extending outwardly fromthe excision site in the bone as generally described in U.S. Pat. Nos.6,520,964, 6,610,067, 6,679,917, and 7,678,151, all of which are fullyincorporated herein by reference. The use of a cannulated passageway 40and the guide wire may facilitate alignment of the anchor 30 withrespect to the excision site and the surrounding articular surface.

As discussed above, the implant 16 may be secured to the anchor 18 byway of a connection. For example, the implant 16 may include at leastone first fixation element 24 configured to engage with at least onesecond fixation element 26 of the anchor 18 to secure the implant 16 tothe anchor 18. According to one embodiment, the first and the secondfixation elements 24, 26 may include one or more recesses, groves, slotsor the like configured to corresponding to one or more protrusions,ribs, barbs, or the like, for example, in a snap-fit arrangement inwhich the first and/or second fixation elements resiliently deflect. Thefirst and second fixation elements 24, 26 may be disposed about theentire perimeter/periphery of the implant 16 and anchor 18, and/or aboutone or more regions of the perimeter/periphery. The first and secondfixation elements 24, 26 may prevent the implant 16 from becoming freerelative to the anchor 18 (for example, to prevent axial and/orrotational movement of the implant 16 relative to the anchor 18).Optionally, the implant 16 may be at least partially received in animplant cavity 28 formed in the anchor 18 such that a bone facingsurface 30 of the implant 16 engages against at least a portion of theimplant cavity 28, thereby preventing the implant 16 from movingdistally when a force is applied to the load bearing surface 22.

It should be appreciated that while the first and second fixationelements 24, 26 are generally illustrated as a recess and a protrusion,respectively, the implant system 10 consistent with the presentdisclosure is not limited to this arrangement unless specificallyclaimed as such. For example, the first and second fixation elements 24,26 may include a protrusion and a recess, respectively, as well as otherembodiments. Additionally, the anchor 18 may optionally include apassageway 40, for example, a longitudinal passageway, configured to beadvanced over a guide wire (not shown) as generally described in U.S.Pat. Nos. 6,520,964, 6,610,067, 6,679,917, 7,678,151, 7,896,883,8,177,841, and 8,388,624, as well as U.S. Publication No. 2010/0368238,all of which are fully incorporated herein by reference. For example,the anchor 18 may be inserted into bone 14 or may be inserted into ashaft drilled in the bone 14 to reduce risks or complications arisingfrom the insertion of the anchor 18. Without limitation, a pilot holemay be formed in the bone 14 for receiving the anchor 18 prior toinstalling the anchor 18. A diameter of the pilot hole may be smallerthan the anchor 18, although example embodiments may vary and are notlimited thereto.

Turning now to FIG. 4 , another embodiment of an implant system 10 whichmay be used with the total joint replacement system 1 consistent withthe present disclosure is generally illustrated. Implant system 10includes an implant (e.g., implant body) 16 configured to be secured toan anchor 18. Implant 16 may be formed of a plastic composition and maymore particularly comprise, essentially consist of, or consist of aplastic composition. Exemplary plastic compositions may comprisethermoplastic compositions such as polyether ether ketone (PEEK) andpolyethylene (PE), including ultrahigh molecular weight polyethylene(UHMWPE) and high density polyethylene (HDPE). In other embodiments,implant 16 may be formed of a metal composition and may moreparticularly comprise, essentially consist of, or consist of a metalcomposition. Exemplary metal compositions may comprise stainless steel,titanium, aluminum, chromium cobalt, and/or any alloy thereof.

Implant 16 has a joint facing side including a load bearing (jointarticulation) surface 22 having any contour as described herein, and abone facing surface 37. Bone facing surface 37 may substantiallycorrespond to a contour of an excision site 20 (FIG. 1 ) formed in anarticular surface 12 of a patient. More particularly, a perimeter of theimplant 20 may substantially corresponds to a perimeter of an excisionsite 20 formed in the articular surface 12.

Bone facing surface 37 includes a first fixation element 32. Firstfixation element 32 comprises a fixation recess 34 formed in a fixationbase 36 of implant 16. As shown, fixation recess 34 is substantiallycylindrical and may be centered around a longitudinal axis LAA of theanchor 18. More particularly, the sidewall 40 of fixation recess 34 istapered

The anchor 18 is configured to engage and/or secure the implant assembly10 to the patient's bone as described herein, for example, using threads21 and/or bone cement. The proximal end region of the anchor 18 includesa second fixation element 44 configured to form a connection with thefirst fixation element 32. As shown by the figures, anchor 18 maycomprise a screw with a fully or partially threaded tapered ornon-tapered cylindrical shank which is arranged substantially transverseto the overlying portion of the load bearing surface 22.

As discussed herein, second fixation element 44 is configured to engagewith the first fixation element 32 to form a connection therebetween. Inthe illustrated embodiment, the second fixation element 44 includes atapered (male) protrusion. The tapered protrusion includes a taperedsidewall 50 configured to contact and abut against at least a portion ofa tapered sidewall 40 of the first fixation element 32 to form africtional connection therebetween. Of course, it should be appreciatedthat the arrangement of the male and female tapers with respect to thefirst and second fixation elements 32, 44 may be switched (e.g., thefirst fixation element 32 may include a male taper and the secondfixation element 44 may include a female taper).

The proximal end region of the anchor 30 may also include a driverreceptacle 52 arranged to receive a drive member therein, particularlyto drive the first anchor 30 into bone. For example, driver receptacle52 may be arranged to receive a drive member (not shown) to cause one ormore anchor elements 56 of the anchor 18 to engage the bone 14. Thedriver receptacle 52 may allow torque to be transmitted to the anchor 18to rotate the anchor 18 such that one or more external screw (helical)threads 21 threadably engage and connect with the bone 14.

Elongated anchor 18 may be formed of a plastic composition and may moreparticularly comprise, essentially consist of, or consist of a plasticcomposition. Exemplary plastic compositions may comprise thermoplasticcompositions such as polyether ether ketone (PEEK) and polyethylene (PE)such as ultrahigh molecular weight polyethylene (UHMWPE) and highdensity polyethylene (HDPE). In other embodiments, anchor 18 may beformed of a metal composition and may more particularly comprise,essentially consist of, or consist of a metal composition. Exemplarymetal compositions may comprise stainless steel, titanium, aluminum,chromium cobalt, and/or any alloy thereof.

Turning now to FIGS. 5-6 , yet another embodiment of an implant system10 which may be used with the total joint replacement system 1consistent with the present disclosure is generally illustrated. Forexample, FIG. 5 generally illustrates one embodiment of an exploded,unassembled implant system 10, and FIG. 6 generally illustrates anassembled implant system 10. Implant 16 has a load bearing surface 22and a bone facing surface 37. The load bearing surface 22 may havecontour as described herein, for example, the original contour of thepatient's articular surface generally corresponding to a plurality ofoverlapping excision sites (e.g., if replacing the dorsal socket or thelike). The bone facing surface 37 may also include a first fixationelement 32 configured to be secured to a second fixation element 44 ofthe anchor 18 to form a connection therebetween. In the illustratedembodiment, the first fixation element 32 includes a tapered (male)protrusion and the second fixation element 44 includes a tapered recess.The tapered protrusion includes a tapered sidewall configured to contactand abut against at least a portion of a tapered sidewall of the taperedrecess to form a frictional connection therebetween. Of course, itshould be appreciated that the arrangement of the male and female taperswith respect to the first and second fixation elements 32, 44 may beswitched (e.g., the first fixation element 32 may include a female taperand the second fixation element 44 may include a male taper).

FIGS. 7 a-7 e generally illustrate cross-sectional views of anotherembodiment of the total joint replacement system 1 consistent with thepresent disclosure at different angles, e.g., ranging between 0° and60°. The total joint replacement system 1 includes a first implantsystem 10 a as generally described herein with respect to FIGS. 5 and 6, and a second implant system 10 b as generally described herein withrespect to FIGS. 2 and 3 . For the sake of clarity, the bones of thejoint are not illustrated.

The anchors 18 a of the first implant system 10 a may be secured to boneas described herein. For example, the height of the anchor 18 a may beadjusted by rotating the anchor 18 a. Optionally, a trial guide (notshown) may be coupled to the anchor 18 a to allow the surgeon to verifythat the load bearing surface 22 is substantially flush with thesurrounding articular surface (if present) and/or generally correspondsto the location of the original articular surface.

The anchor 18 b of the second implant system 10 b may also be secured tothe bone as described herein. Similarly, the height the anchor 18 b maybe adjusted by rotating the anchor 18 b, and optionally using an implanttrial guide (not shown). One advantage of the total joint replacementsystem 1 is that the height of the anchors 18 a, 18 b may be infinitelyadjusted, and once adjusted to the desired height, the implant 16 a, 16b may be secured to the anchors 18 a, 18 b in the correct orientation.For example, the implant 16 a (because it has a non-symmetrical loadbearing surface 22) should be aligned in a predetermined orientationwith respect to the bone (e.g., the metatarsal bone). Similarly, theimplant 16 b should be aligned in a predetermined orientation withrespect to the phalangeal bone and/or the first implant 16 a (e.g., theimplant 16 b may have a generally convex contour configured to generallyalign with and slide against the implant 16 a as generally illustratedin FIGS. 7 a-7 e ). Thus, the height and/or separation distance betweenthe bones (e.g., metatarsal and phalangeal bones) may be infinitelyadjusted without impacting the alignment of the implants 16 a, 16 b(i.e., the alignment of the implants 16 a, 16 b may be independent ofthe position of the anchors 18 a, 18 b).

Turning now to FIG. 8 , yet another embodiment of the total jointreplacement system 1 is generally illustrated. The total jointreplacement system 1 includes a first and a second implant system 10 a,10 b similar to the implant systems 10 as generally described hereinwith respect to FIGS. 2 and 3 . In particular, the first implant system10 a includes an implant 16 a having a generally convex load bearingsurface 22 a and the second implant system 10 b includes an implant 16 bhaving a generally concaved load bearing surface 22 b configured to matewith load bearing surface 22 a.

Turning now to FIGS. 9-17 , systems and methods for securing an anchor18 into the bone and securing the implant 16 to the anchor 18 using animplant delivery system 100 consistent with the present disclosure aregenerally illustrated. In a first mode (as generally illustrated inFIGS. 9-13 ), the implant delivery system 100 may be used to secure theanchor 18 into an excision site formed in the bone. In a second mode(FIGS. 14-17 ), the delivery system 100 may be used to secure theimplant 16 to the anchor 18 to assemble the implant system 10 within theexcision site. As may be appreciated, the implant delivery system 100may be used with any implant system 10 described herein and is notlimited to the illustrated implant system 10 unless specifically claimedas such.

With reference to FIGS. 9-13 , one embodiment of system and method forusing the implant delivery system 100 to secure the anchor 18 to bonewithin an excision site is generally illustrated. The implant deliverysystem 100 may include a driver 110, a biasing body 112, and at leastone suture 114. As explained herein, the implant delivery system 100 maybe configured to retain the anchor 18 into engagement with the driver110 and to secure the anchor 18 to bone 14 within an excision site 20(as generally illustrated in FIGS. 12 and 13 ). For example, the driver110 may be received through the biasing body 112, and the suture 114 maybe disposed around a portion of the anchor 18 to provide increasedcontrol and/or maintain contact between the driver 110 and the anchor 18while securing the anchor 18 into the bone 14 within the excision site20. The excision site 20 may be formed using any method and system knownto those skilled in the art.

The driver 110, FIG. 9A, includes a longitudinally disposed shaft 116having an engagement portion 118 disposed about a distal end 120. Theengagement portion 118 is configured to be coupled with a correspondingengagement portion 122 of the anchor 18 and to transmit torque asgenerally illustrated in FIGS. 10-12 . For example, the engagementportion 118 may be a male-shaped coupling unit (such as, but not limitedto, a splined or hex-shaped driver) configured to couple with afemale-shaped coupling unit 122 (such as, but not limited to, a splinedor hex-shaped recession formed in the anchor 18) in order to rotate ordrive the anchor 18 into the bone. However, the engagement portions 118,122 may vary and are not limited thereto. For example, the driver 110may be configured to accept interchangeable bits having a differentengagement portion 118 configurations, thereby allowing the engagementportion 118 of the driver 110 to be coupled to the engaging portion 122of the anchor 18 using several different bits as necessary.Alternatively (or additionally), the engagement portion 118 may have afemale-shaped coupling unit and the anchor 18 may have a male-shapedcoupling unit. The shape of the engaging portions 118, 122 may be otherthan splined or hexagonal, and those in the art will recognize that oneof any number of shapes or configuration for such components may beemployed in a device or method consistent with example embodiments.Optionally, the engagement portion 118 may be magnetized or otherwiseconfigured to maintain contact or control over the anchor 18.

While the engaging portion 122 of the anchor 18 is shown located on aninner wall of the narrow portion of the anchor 18, example embodimentsmay vary and are not limited thereto. For example, the engaging portion122 of the anchor 18 may be located on an inner wall of the wide portionof the anchor 18 and/or on an outer wall of either the narrow portion orthe wide portion of the anchor 18. Optionally, an intermediate oradapting portion (not shown) may be used to connect the driver 110 tothe anchor 18.

The driver 110 may optionally include a handle 124. The handle 124 mayfacilitate grasping of the driver 110 and may be configured to cause arotational force or a torque on the shaft 116, which may ultimatelyimpart a rotational force or torque on the anchor 18 to secure theanchor 18 into the bone. The handle 124 may be separate from the shaft116 (either permanently or removably coupled thereto), or may be aunitary, single piece with the shaft 116. While the handle 124 isillustrated as having a larger width than the shaft 116, exampleembodiments may vary and are not limited thereto. For example, thehandle 124 may include a lever arm or may be configured to couple to alever arm that is used to create the rotational force or torque.

The handle 124 and/or the shaft 116 may be cannulated to define alongitudinal passageway 126. The longitudinal passageway 126 may includeproximal and distal openings 128 a, 128 b configured to be advanced overa guide wire (not shown for clarity), for example, when securing theanchor 18 into the bone within the excision site.

The biasing body 112 defines a shaft passageway 132 extending between afirst and a second end region 130 a, 130 b having a first and secondopening 134 a, 134 b. The shaft passageway 132 is configured to receiveat least a portion of the shaft 116 of the driver 110, for example, asgenerally illustrated in FIGS. 10 and 11 . The shaft 116 and the shaftpassageway 132 may be configured such that the distal end 120 of theshaft 116 extends beyond the second end 134 b of the shaft passageway132 to allow the engagement portion 118 of the driver 110 to engage thecorresponding engagement portion 122 of the anchor 18, for example, asgenerally illustrated in FIGS. 10 and 11 . Optionally, the biasing body112 may include a driver cradle 121, discussed in greater detail herein,which may be used to secure the implant 16 (not shown) with the anchor18.

Additionally, the second end region 130 b may include a fixation element25 (FIG. 9B) which substantially corresponds to the first fixationelement 24 of the implant 16. In this manner, the fixation element 25 ofthe second end region 130 b of the biasing body 112 may be coupled tothe second fixation element 26 of the anchor 18 to generally secure theanchor 18 to the biasing body 112. The connection between the biasingbody 112 and the anchor 18 may facilitate placement of the anchor 18within the excision site by creating a generally secure connectiontherebetween. It may be appreciated, however, that the connectionbetween the fixation element 25 of the second end region 130 b and thesecond fixation element 26 of the anchor 18 does not need to be asstrong as the connection between the first and second fixation elements24, 26 since it is only generally intended to help advance the anchor 18to and align the anchor 18 within the excision site.

Alternatively (or in addition to), the biasing body 112, FIG. 9A, may beconfigured to receive a suture 114 disposed around (e.g., wrap around) aportion of the anchor 18. Tension may be applied to the suture 114 togenerally urge the anchor 18 into contact with the driver 110 and/or thebiasing body 112 to provide more control over and/or maintain contactbetween the driver 110 and the anchor 18. The suture 114 may beconfigured to extend through and/or around the biasing body 112 in anymanner known to those skilled in the art. For example, the suture 114may extend through the first opening 134 a of the shaft passageway 132of the biasing body 112, out through one or more sutureapertures/openings/passageways 136 a, 136 b, through one or more suturealignment guides 138 a, 138 b and around a contact portion 140 of theanchor 18. The suture passageways 136 a, 136 b may allow the suture 114to pass from the exterior of the biasing body 112 to the interior of theshaft passageway 132. While the suture passageways 136 a, 136 b areillustrated in the middle of the biasing body 112, example embodimentsmay vary and are not limited thereto. It should also be appreciated thatthe suture 114 does not have to pass through the shaft passageway 132,and instead the biasing body 112 may include one or more separatepassageways (not shown) for the suture 114.

The suture alignment guides 138 a, 138 b are configured to retain thesuture 114 about the distal end of the biasing body 112. According toone embodiment, the suture 114 may include a first and a second portion142 a, 142 b (best seen in FIG. 11 ) which form a basket, cradle, orframe 144 extending about the contact portion of the anchor 18. Thefirst and second portions 142 a, 142 b may be formed from two or morepieces of suture, or may be formed from a single piece of suture. Thesuture alignment guides 138 a, 138 b may be configured to prevent thefirst and second portions 142 a, 142 b of the cradle 144 from slippingoff the anchor 18 by restricting the separation angle S of the first andsecond portions 142 a, 142 b of the cradle 144.

While the suture alignment guides 138 a, 138 b are shown at the distalend of the biasing body 112 nearest the anchor 18, example embodimentsmay vary and are not limited thereto. For example, the suture alignmentguides 138 a, 138 b may be located anywhere along the biasing body 112provided the suture alignment guides 138 a, 138 b may prevent the suture114 from slipping off the anchor 18. Additionally, while the suturealignment guides 138 a, 138 b are shown as an exterior protrusion of thebiasing body 112 with holes to allow the suture 114 to pass through,example embodiments may vary and are not limited thereto. For example,the suture alignment guides 138 a, 138 b may be flush with the biasingbody 112 or may protrude in an arc shape, with a gap between one edge ofthe suture alignment guides 138 a, 138 b and the biasing body 112 toallow the suture 114 to enter. It may also be appreciated that thelength of the suture alignment guides 138 a, 138 b may vary and thesuture alignment guides 138 a, 138 b may be integrated into the suturepassageways 136 a, 136 b.

While the contact portion 140 of the anchor 18 is shown on the bottomedge of the anchor 18, example embodiments may vary and the contactportion 140 may be situated anywhere along the anchor 18. For example,the contact portion 140 may also be disposed about the top portion ofanchor 18. The contact portion 140 of the anchor 18 may include a flatedge or may include guides, grooves, slots, or channels configured toreceive the suture 114. For example, the suture 114 may extend through apassageway formed in the anchor 18 such that a portion of the anchor 18generally surrounds the suture 114, and the cradle 144 may beeliminated.

To secure the anchor 18 to the bone 14 within the excision site 20, thesuture 114 may be received through the biasing body 112 (e.g., throughthe first opening 134 a of the shaft passageway 132, out through thesuture passageways 136 a, 136 b, and through the suture alignment guides138 a, 138 b) such that the cradle 144 is disposed about the contactportion 140 of the anchor 18 as generally illustrated in FIG. 9A. Thedriver 110 may be advanced through shaft passageway 132 until theengagement portion 118 contacts the corresponding engagement portion 122of the anchor 18. The suture 114 may then be tensioned to retain theengagement between the driver 110 and the anchor 18, for example, byapplying a force against the suture 114 in a direction generally awayfrom the anchor 18 as generally illustrated in FIGS. 10 and 11 .Alternatively (or in addition), the fixation element 25 (FIG. 9B) of thebiasing body 112 may be secured to the fixation element 26 of the anchor18, and the driver 110 may engage the anchor 18 as described herein.

With the anchor 18 securely engaged with the driver 110, the anchor 18may be advanced to and aligned with the excision site 20 (as generallyillustrated in FIG. 12 ) formed in the patient's articular surface 12and bone 14. Optionally, the anchor 18 may be aligned with the excisionsite 20 using a guide wire 146 extending outwardly from the bone 14within the excision site 20. Because the anchor 18 is retained againstthe driver 110, it is easier for the surgeon to align the anchor 18relative to the excision site 20. As discussed herein, the anchor 18 mayoptionally include a cannulated passageway 32 (best seen in FIG. 9A)that is generally aligned with (e.g., generally co-axial) thelongitudinal passageway 126 of the driver 110 (as best illustrated inFIG. 12 ) such that the anchor 18 and the driver 110 (and optionally thebiasing device 112) may be advanced over the guide wire 146. Theoptionally use of the cannulated passageway 32 and the guide wire 146may further aid in aligning the anchor 18 at the desired angle withrespect to the excision site 20 and the surrounding articular surface12.

Once the anchor 18 is aligned with respect to the excision site 20, thedriver 110 may then be used to secure the anchor 18 into the bone 14,for example, by rotating the driver 110, thereby causing the anchor 18to rotate. The height of the anchor 18 may be verified using a trialgauge (not shown) which may be easily inserted/placed into the anchor 18to ensure that the implant 16 (e.g., FIG. 1 ) is substantially flushwith the surrounding articular surface 21. Once the height of the anchor18 is verified, the driver 110 (and optionally the biasing device 112and/or the guide wire 146) may be removed, leaving the anchor 18 (andoptionally the suture 114) remaining in the bone 14, as generallyillustrated in FIG. 13 . While the anchor 18 is illustrated havingthreads 21, it may be appreciated that the anchor 18 may be secured tothe bone 14 using any device(s) known to those skill in the artincluding, but not limited to, ribs, barbs, bone cement, porousstructures, and the like.

It should also be appreciated that the biasing device 112 does not haveto be used when advancing and/or aligning the anchor 18 with respect theexcision site 20. For example, the biasing device 112 may be eliminatedand tension may be applied to the suture 114 to keep the anchor 18engaged with the driver 110. Alternatively, the anchor 18 may beadvanced to and aligned with the excision site 20 without using thedriver 110. For example, the suture 114 may be secured about a portionof the anchor 18, and once the anchor 18 is aligned within the excisionsite 20, the driver 110 may engage the anchor 18 and used to secure theanchor 18 within the excision site 20 in the bone 14.

Turning now to FIGS. 14-17 , systems and methods for securing an implant16 to the anchor 18 using an implant delivery system 100 consistent withthe present disclosure are generally illustrated. As discussed herein,the implant delivery system 100 may be configured to generate a biasingforce to secure the implant 16 to the anchor 18 wherein the biasingforce is only applied against the implant 16 and the anchor 18, and notthe surrounding bone or tissue 14.

With the anchor 18 secured to the bone 14 and the suture 114 disposedabout the contact portion 140 of the anchor 18 as described herein, theimplant 16 may be arranged (i.e., placed) between the anchor 18 and thesecond end region 130 b of the biasing device 112 as generallyillustrated in FIGS. 14 and 15 . The suture 114 may extend around thecontact portion 140 of the anchor 18, through suture alignment guides138 a, 138 b and suture passageways 136 a, 136 b, and exit through thefirst opening 134 a of the shaft passageway 132 of the biasing body 112.The suture 114 may also be generally coupled or secured to a portion ofthe driver 110, for example, a portion of the shaft 116. For example,the driver 110 may include a suture engagement 148 configured to allowthe suture 114 to be generally fixed or retained by the driver 110.

According to one embodiment, the suture engagement 148 may include ahole or aperture through the shaft 116. At least a portion of the suture114 may pass through the hole 148, and the suture 114 may be securedwithin the suture engagement 148 as the driver 110 is rotated to reducethe length L of the suture 114 between the driver 110 and the anchor 18as explained herein. It should be appreciated that the suture engagement148 may include any device for generally securing the suture 114 to thedriver 110. For example, the suture engagement 148 may include anexternal protrusion, a groove, non-cylindrical region, and/or a slotconfigured to secure the suture 114. Alternatively, the suture 114 maybe wrapped around the shaft 116, and the tension generated by therotation of the driver 110 may secure the suture 114 thereto. The lengthof the biasing body 112 may be selected to allow the surgeon sufficientroom to rotate the driver 110, and therefore may depend on the intendedapplication.

With the suture 114 generally secured to the driver 110, the driver 110may be rotated about its longitudinal axis A as it is received withinthe driver cradle 121. The driver cradle 121 may be configured toreceive the driver 110 (e.g., the shaft 116) and generally retain theshaft 116 as the shaft 116 is rotated relative to the biasing body 112.For example, the driver cradle 121 may include one or ore recesses,grooves, or lips formed in the first end region 134 a of the biasingbody 112. The driver cradle 121 may also include one or more holes orpassageways formed through the biasing body 112 configured to receiveand generally retain the shaft 116.

Optionally, the driver cradle 121 may include an enlarged opening 150(best seen in FIG. 9 ). As the driver 110 is rotated, the suture 114begins to wrap around the shaft 116, thereby increasing the diameter ofthe shaft 116. The enlarged opening 150 provides a void space that thesuture 114 can pass through as the driver 110 is rotated and the suture114 builds up around the shaft 116. As a result, the suture 114 maygenerally avoid contact with the driver cradle 121, and the torquenecessary to rotate the driver 110 may be reduced.

Turning now to FIGS. 16 and 17 , with the implant 16 disposed betweenthe anchor 18 and the second end region 132 b of the biasing body 112,and the driver 110 (along with the suture 114 generally secured thereto)disposed within the driver cradle 121, the surgeon may rotate the driver110 about longitudinal axis A to reduce the length L of the suture 114extending between the driver 110 and the contact portion 120 of theanchor 118. The reduction in the length L of the suture 114 generates abiasing force which urges the implant 16 into engagement with the anchor18. As may be appreciated, the implant delivery system 100 generates abiasing force which is applied against the implant 16 and anchor 18through the suture 114 only (i.e., substantially no force is applied tothe surrounding bone 14 or tissue).

More specifically, because the suture 114 supports the anchor 18,rotation of the driver 110 about longitudinal axis A increases thetension on the suture 114 (and therefore the biasing force between theimplant 16 and the anchor 18) in an opposite direction of the downwardforce being placed upon the implant 16 by the biasing body 112.Continued rotation of the driver 110 increases the biasing force betweenthe implant 16 and the anchor 18 and, once the biasing force exceeds therequired threshold to install the implant 16, the implant 16 may besuccessfully installed (e.g., secured) in the anchor 18. Thus, as aresult of the suture 114 applying a relatively equal and opposite forceto the anchor 18 and the biasing device 110 (and therefore the implant16), the underlying bone 14 and other structures are not affected,preventing or reducing potential injury from securing the implant 16into the anchor 18. The implant delivery system 100 therefore avoidsand/or reduces any impact to the bone 14 (e.g., eliminates blunt forcedue to a hammer/mallet or the like), and therefore avoids and/or reducesdamage to the bone 16.

Because the biasing force is not transmitted/applied into thesurrounding bone 14 or tissue, the implant delivery system 100 may beused with small bones (such as, but not limited to, phalange bonesand/or metatarsal bones in the foot and/or hands. Additionally, becausethe implant delivery system 100 is capable of generating high biasingforces without transmitting/applying the biasing force to thesurrounding bone 14 or tissue, the connection between the implant body16 and the anchor 18 (e.g., first and second fixation elements 24, 26 asdiscussed herein) may be stronger and more robust, thereby increasingthe life expectancy of the implant system 10. Moreover, the implantdelivery system 100 may deliver the biasing force uniformly to theimplant 16 and be self-leveling or self-aligning, thereby reducingand/or eliminating the difficulties associated with aligning the implant16 with respect to the anchor 18.

Once the implant 16 is secured to the anchor 18, the suture 114 may beremoved from the implant system 10. For example, one or more portions ofthe suture 114 may be cut and the resulting pieces may be removed (e.g.,pulled out) from the excision site 20. Alternatively, a first end of thesuture 114 may be released and the suture 114 may be pulled through thebiasing body 120 by a second end of the suture 114, resulting in thefirst end traveling through the shaft passageway 132 c, through one ofthe suture passageways 136 a, 136 b, out one of the alignment guides 138a, 138 b, around the anchor 18 and through the second of the alignmentguides 138 a, 138 b and suture passageways 136 a, 136 b, and the shaftpassageway 132. However, example embodiments may vary and are notlimited thereto.

If the suture 114 is cut prior to removal, example embodiments may varyand may include the suture 114 having various shapes or loops. Forexample, the suture 114 may form a basket or loop to wrap around theanchor 18. This shape may help support the anchor 18 and may increasecontrol over the anchor 18 prior to the suture 114 being wrapped aroundthe driver 110. In this configuration, the loop may extend so that theloop can be severed after installation of the implant system 10.

It may be appreciated that the strength or ruggedness of the snap-fitconnection between the implant 16 and the anchor 18 may depend on theselected materials (e.g., the rigidity) and size/dimensions. In general,more rigid (i.e., less deformable) materials and/or largersizes/dimensions will result in a stronger, more robust connectionbetween the implant 16 and the anchor 18. While a stronger and morerobust connection between the implant 16 and the anchor 18 is generallydesirable, the resulting force necessary to make the snap-fit connectionincreases.

Traditionally, the force necessary to secure the implant 16 to theanchor 18 has been generated using a blunt force, e.g., a hammer/malletor the like. More specifically, with the anchor 18 secured in the bone14, the surgeon attempts to align the implant 16 relative to the anchor18 and impacts the implant 16 with the hammer/mallet to force theimplant 16 into engagement with the anchor 18. As may be appreciated,however, a substantial amount of force is also applied to thesurrounding bone 14, and if the force applied to the bone 14 is toogreat, the bone 14 may be damaged. Consequently, the strength of theconnection between the implant 16 and the anchor 18 may be limited inmany applications (e.g., but not limited to, small bones in the hand andfoot as well as implant system 10 installed proximate to the perimeterof a bone) by the strength of the surrounding bone 14. Additionally, itmay be very difficult for the surgeon to properly align the implant 16with respect to the anchor 18.

As discussed herein, the implant delivery system consistent with oneembodiment of the present disclosure solves this problem by generating abiasing force to secure the implant 16 to the anchor 18 wherein thebiasing force is only applied against the implant 16 and the anchor 18.The biasing force generated by the implant delivery system may thereforebe applied only to the implant system 10, and not the surrounding boneor tissue 14. An implant delivery system consistent with the presentdisclosure may also be used to facilitate securing the anchor 18 intothe bone 14.

It should be appreciated that the implant system 10 illustrated withrespect to FIGS. 9-17 is provided for illustrative purposes, and thatthe implant delivery system may be used with any multi-piece implanthaving an anchor that is coupled (either directly or indirectly) to animplant/implant body. For example, the implant delivery system may beused with implant systems for replacing any articular surface such as,but not limited to, shoulder joints (e.g., but not limited to, theglenohumeral joint), hip joint (e.g., but not limited to, theacetabulofemoral joint), foot and/or hand joints (e.g., but not limitedto, metacarpophalangeal joints, metatarsophalangeal joints, and/orinterphalangeal joints), or the like. The implant systems may includetotal joint implants (wherein all or substantially all of the articularsurface of at least one bone is replaced with the artificial surface ofthe implant) and/or partial implants (wherein substantially only thedamaged portion(s) of the articular surface of a bone is replaced withthe artificial surface of the implant). The implant delivery system mayalso be used to secure together a multi-piece pin or rod in a bone tofacilitate healing of a fracture or broken bone.

Turning now to FIG. 18 , yet another embodiment of the total jointreplacement system 1 consistent with the present disclosure is generallyillustrated. The total joint replacement system 1 may include firstimplant system 10 a and a second implant system 10 b. While the totaljoint replacement system 1 will be described in terms of a shoulderjoint, it should be appreciated that this is not a limitation of thepresent disclosure unless specifically claimed as such. For the sake ofclarity, the bones are not illustrated.

The first implant system 10 a may be configured to replace and/or repairthe humeral head, and may be similar to the implant system 10 describedwith respect to FIGS. 4 and 5-6 . The implant 16 a may include a firstfixation element 32 configured to be secured to the second fixationelement 44 of the anchor 18 a as described herein (e.g., using one ormore first fixation elements 32 configured to be secured to one or moresecond fixation elements 44). The anchor 18 a may be secured, forexample, into the humerus. The implant 16 a may have a generallyhemispherical configuration, for example, which generally corresponds tothe humeral head (e.g., a “ball shape”). The implant 16 a (e.g., thefirst fixation element 32) may be configured to be secured to the anchor18 a (e.g., the second fixation element 44) at any angle A. For example,the angle A may be defined by the longitudinal axis LAA of the anchor 18a and the longitudinal axis LAI of the implant 16 a. The angle A may bedetermined based on the amount of the humeral head removed with respectto the rest of the humerus. The angle A may include any angle within therange of 0 degrees to approximately 90 degrees, for example, within therange of 0 degrees to approximately 45 degrees, within the range of 0degrees to approximately 25 degrees, and/or within the range of 0degrees to approximately 15 degrees, including all values and rangestherein.

The second implant system 10 b may be configured to replace and/orrepair the glenoid. The second implant system 10 b may include anyimplant system/assembly as described in U.S. Provisional ApplicationSer. No. 61/949,789, filed Mar. 7, 2014, which is fully incorporatedherein by reference.

The total joint replacement system 1 as generally illustrated in FIG. 18may therefore repair and/or replace the shoulder joint. Turning now toFIG. 19 , yet a further embodiment of the total joint replacement system1 consistent with the present disclosure is generally illustrated. Thetotal joint replacement system 1 of FIG. 19 may include first implantsystem 10 a and a second implant system 10 b, and may be used to repairand/or replace a shoulder joint (though it should be appreciated thatthis is not a limitation of the present disclosure unless specificallyclaimed as such). For the sake of clarity, the bones are notillustrated.

The total joint replacement system 1 may be referred to as a “reverseshoulder.” The shoulder may be thought of as a ball and socket joint inwhich he humeral head is a ball and the glenoid is a socket. In thetotal joint replacement system 1 of FIG. 19 , the orientation of theball is socket is reversed. As such, implant system 10 a (which may besecured to the humerus) may include an anchor 18 a and an implant 16 ahaving a load bearing surface 22 at least partially defining a socket200. The implant 16 a may be disposed at an angle A with respect to theanchor 18 a as described herein.

The second implant system 10 b may include an implant 16 b and an anchor18 b. The implant 16 b may be secured to the anchor 18 b as generallydescribed herein (e.g., using one or more first fixation elements 32configured to be secured to one or more second fixation elements 44).The implant 16 b may include an implant body 202 and a support plate204. The implant body 202 may define a load bearing surface 22 b, forexample, having a generally hemi-spherical configuration (e.g., ball)configured to articulate in the socket 200 of the first implant system10 a. The implant body 202 may be secured to the support plate 204 inany manner known to those skilled in the art. For example, the implantbody 202 may be secured to the support plate 204 using a taperedconnection similar to the first and second fixation elements 32, 44 asdescribed herein. The support plate 204 may optionally include one ormore apertures 206 configured to receive anchoring screws 208. Theanchoring screws 208 aid in securing the support plate 204 (andtherefore the implant 18 b) to the bone.

According to one embodiment, the total joint replacement system 1 ofFIG. 18 may be partially replaced with the total joint replacementsystem 1 of FIG. 19 . In particular, a patient may initially have thetotal joint replacement system 1 of FIG. 18 installed in the shoulderjoint. If it is later desired to replace the total joint replacementsystem 1 of FIG. 18 with a reverse shoulder, the anchors 18 a, 18 b ofFIG. 18 may remain secured within the humerus and glenoid, respectively.The implants 16 a, 16 b of FIG. 18 may be removed and replaced with theimplants 16 a, 16 b of FIG. 19 . Leaving the anchors 16 a, 16 b of FIG.18 within the bones reduces the potential for damage to the bones ifcorrective surgery is later needed. As such, any of the implants 10 thatmay be used with the total joint replacement system 1 of the presentdisclosure may be considered modular.

The terms and expressions which have been employed herein are used asterms of description and not of limitation, and there is no intention,in the use of such terms and expressions, of excluding any equivalentsof the features shown and described (or portions thereof), and it isrecognized that various modifications are possible within the scope ofthe claims. Accordingly, the claims are intended to cover all suchequivalents. Various features, aspects, and embodiments have beendescribed herein. The features, aspects, and embodiments are susceptibleto combination with one another as well as to variation andmodification, as will be understood by those having skill in the art.The present disclosure should, therefore, be considered to encompasssuch combinations, variations, and modifications.

All definitions, as defined and used herein, should be understood tocontrol over dictionary definitions, definitions in documentsincorporated by reference, and/or ordinary meanings of the definedterms.

The indefinite articles “a” and “an,” as used herein in thespecification and in the claims, unless clearly indicated to thecontrary, should be understood to mean “at least one.”

The phrase “and/or,” as used herein in the specification and in theclaims, should be understood to mean “either or both” of the elements soconjoined, i.e., elements that are conjunctively present in some casesand disjunctively present in other cases. Other elements may optionallybe present other than the elements specifically identified by the“and/or” clause, whether related or unrelated to those elementsspecifically identified, unless clearly indicated to the contrary.

All references, patents and patent applications and publications thatare cited or referred to in this application are incorporated in theirentirety herein by reference.

What is claimed is:
 1. A joint replacement system for repairing a firstarticular surface and a second articular surface corresponding to ahumerus and a oppositely arranged glenoid cavity, respectively, saidsystem comprising: a humerus implant system comprising: a first implanthaving a first load bearing surface; and a first anchor having a firstthreaded region configured to be secured into said humerus, wherein saidfirst anchor is configured to be secured to said first implant; and aglenoid cavity implant system comprising: a second implant having ahemispherical load bearing surface configured to articulate against saidfirst load bearing surface; and a second anchor having a second threadedregion configured to be secured into said glenoid cavity, wherein saidsecond anchor is configured to be secured to said second implant; and asupport plate, said support plate configured to be secured to saidsecond anchor and further configured to be secured to said secondimplant.
 2. The joint replacement system of claim 1, wherein said secondimplant and said second anchor include a first and a second fixationelement, respectively.
 3. The joint replacement system of claim 2,wherein said first and said second fixation elements are configured toform tapered connection therebetween.
 4. The joint replacement system ofclaim 3, wherein said first and said second fixation elements comprise atapered cavity and a tapered protrusion configured to form a taperedconnection therebetween.
 5. The joint replacement system of claim 2,wherein said second anchor includes a longitudinal passageway.
 6. Thejoint replacement system of claim 5, further comprising a guide wireconfigured to be at least partially received within said longitudinalpassageway of said second anchor.
 7. The joint replacement system ofclaim 2, wherein said first and said second fixation elements areconfigured to form a snap-fit connection therebetween.
 8. The jointreplacement system of claim 7, wherein said second anchor defines animplant cavity configured to receive at least a portion of a bone facingsurface of said second implant.
 9. The joint replacement system of claim8, wherein at least a portion of a periphery of said cavity includessaid second fixation element and wherein at least a portion of said bonefacing surface includes said first fixation element.
 10. The jointreplacement system of claim 1, wherein said first load bearing surfaceis configured to replace substantially the entire first articularsurface.
 11. The joint replacement system of claim 1, wherein saidsecond load bearing surface is configured to replace a portion of saidsecond articular surface.
 12. The joint replacement system of claim 1,wherein said first load bearing surface has a contour based on aplurality of overlapping excision sites.
 13. The joint replacementsystem of claim 1, wherein said first load bearing surface has a contourdefining a socket.
 14. The joint replacement system of claim 1, whereinsaid support plate includes a first fixation element configured to becoupled to a second fixation element of said first anchor.
 15. The jointreplacement system of claim 14, wherein said first and said secondfixation elements are configured to form tapered connectiontherebetween.
 16. The joint replacement system of claim 14, wherein saidfirst and said second fixation elements are configured to form asnap-fit connection therebetween.
 17. The joint replacement system ofclaim 1, wherein said support plate includes a first fixation elementconfigured to be coupled to a second fixation element of said secondimplant.
 18. The joint replacement system of claim 17, wherein saidfirst and said second fixation elements are configured to form taperedconnection therebetween.
 19. The joint replacement system of claim 17,wherein said first and said second fixation elements are configured toform a snap-fit connection therebetween.
 20. The joint replacementsystem of claim 1, wherein said support plate further includes at leastone aperture configured to receive a fastener configured to secure saidsupport plate into said humerus.
 21. The joint replacement system ofclaim 1, wherein said second load bearing surface has a contour based ona portion of said second articular surface.